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Online Registration is open for Summer 2017!

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office and your credit card will be charged in real time via our secure server.

Check our Dates and Fees here.
To complete standard registration, please fill out the form below. To work out an individualized payment plan, click here to contact us.

To print form and mail it in, click here. (Right-click to open PDF in new window)

Note: Please use a separate form for each child.

Please fill out this form using your computer (not phone), using Internet Explorer or Chrome.

 

SPACE IN CAMP IS LIMITED.

IN ORDER TO REGISTER,

PLEASE CALL FOR AVAILABILITY. 

 

Camper/Parent Information
Child's Info
    First Name
Last Name
Hebrew Name  Sex
MF
Address
    Street
City
State
Zip
Date of Birth
    Month:
Day:
Year:
 
Home Info     Primary Phone
   
Mother's Info
    Title
Mother's Name
Hebrew Name  
      Daytime Phone
Cell
Mother's Email
Father's Info
    Title
Father's Name
Hebrew Name  
      Daytime Phone
Cell
Father's Email
Emergency Contact Info
    Name
Phone Cell Phone  
     Relationship   
Child's School/Playgroup Experience
    My child does not currently attend school or playgroup.  
    My child attends school or playgroup.  
 
    School/Playgroup child attends:
Grade:
 
 
    School/Playgroup child will attend in fall:
Grade:
 
 
 
General Information:
List friends with whom you want your child grouped:
(We will attempt to accommodate your preference.)
 
T-Shirt Size (free):     2T3T 4T5-6 7
Sleeves     Short-sleeve Long-sleeve
Remarks (include medical, behavioral, or dietary information):
 
I hereby apply to enroll my child in Junior Gan Israel Day Camp for:
       
Choose dates:    
 
Choose Program and Program Options:
Expanding Horizons
2 1/2 - 6 yrs. old
  Mon - Fri
9:30 am - 1:00 pm
  Mon-Fri
9:30 am - 3:30 pm  (Afternoon Enrichment)
 
 Space in Bright Beginnings is limited. Please call for more options and availability.
Bright Beginnings
2 - 3 yrs. old
  Mon through Fri
9:30-12 (or 1)
  Tues, Thurs
9:30-12 (or 1)
Mon, Wed, Fri
9:30-12 (or 1)
      Mon through Fri
9:30-3:30
  Tues, Thurs
9:30-3:30
Mon, Wed, Fri
9:30-3:30
 
Tots Club
1  - 2 1/2 yrs. old
           
 
Optional Transportation
 
  Yes, I would like to make a contribution of $ to help a needy child enjoy summer at Junior Gan Israel.
   
 
IMPORTANT
• A non-refundable initial payment of ½ the amount must be submitted with the application. If paying with credit card, your card will be charged upon submission.
• Your balance must be paid by June 1.
• No invoice will be sent.
• I understand that registering my child for camp is a commitment to pay in full, and that payments to camp are non-refundable.
 
Payment Information
Please charge the full amount to my card now.
Please charge the balance automatically to my card on June 1st.

 

 
Name as it appears on card:   First
Middle
Last
 
Billing Address
  Street
City State
Zip
Credit Card
  Card Number
Card Type
Exp (MM/YYYY)
CVV      ?
 
Program: Options:   Price:
 
 
            
 
 
           
 
 
 
 
     
    Subtotal:
 
   
Payment 50%
 
                  
   
 
             
 
     
    Total being charged now
 
     
    Balance
 
    

 

          

I agree to indemnify and hold harmless Junior Gan Israel and its employees in case of injury, G-d forbid. I give my child permission to participate in all activities, and for medical treatment to be administered in case of emergency.

       

Initial here to indicate you have read and agree to these terms:

 
  Date of Application:
 

 

 

 

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Junior Gan Israel Day Camp 4059 Dempster Street Skokie, IL 60076 847-677-1770 Ext. 301
A branch of the world's largest Jewish Camping network, Camp Gan Israel International

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